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Prévalence des troubles dépressifs chez l'enfant et l'adolescent consultant en médecine générale

Doi : ENC-10-2003-29-5-0013-7006-101019-ART2 

F. MATHET [1],

C. MARTIN-GUEHL [2],

S. MAURICE-TISON [3],

M.-P. BOUVARD [4]

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Résumé

Les troubles dépressifs de l'enfant et de l'adolescent étant peu étudiés en médecine générale, nous avons réalisé une enquête épidémiologique auprès de généralistes recevant des sujets âgés de 7 à 17 ans pour des motifs divers. Les objectifs étaient d'estimer la prévalence des troubles dépressifs en médecine générale, de repérer l'existence éventuelle de formes cliniques particulières, d'évaluer la fréquence des troubles comorbides et d'évaluer la reconnaissance de ces troubles par les généralistes. La méthode a comporté une étape de dépistage par auto-questionnaire (Center for Epidemiological Studies Depression Scale) et questionnaire parental (Children Behavior Checklist) remis aux 10 premiers sujets âgés de 7 à 17 ans venant consulter. La deuxième étape, dite de confirmation diagnostique concernait les sujets initialement repérés, qui ont passé un entretien semi-structuré (Schedule for Affective Disorders and Schizophrenia for school-aged children) . Résultats : 155 enfants âgés de 7 à 17 ans ont été évalués. Plus d'1 enfant de moins de 13 ans sur 10 présentent un trouble dépressif. La prévalence en population adolescente est de 5 %. Tous les épisodes dépressifs majeurs retrouvés sont d'intensité modérée. La dépression dite atypique, dans l'acception anglo-saxonne, est présente chez la moitié des adolescents déprimés. Nous avons observé des taux de comorbidité de l'ordre de 50 %. La fréquence et les motifs de consultation ne discriminent pas les enfants déprimés des autres. Les antécédents personnels psychiatriques sont liés à la dépression tandis que la survenue d'un deuil positive le score de la CES-D sans être significativement associée à une dépression avérée. Nous avons estimé que 70 % des diagnostics de dépression n'étaient pas faits lors de la consultation chez le généraliste.

Abstract

Prevalence of depressive disorders in children and adolescents attending primary care. A survey with the Aquitaine Sentinelle Network

Since depressive disorders in children and adolescents have not been widely studied in the context of general medicine, we conducted an epidemiological survey among general practitioners (GP's) consulted by young subjects aged 7 to 17 years for various reasons. Objective - The aims were the following : to estimate the prevalence of depressive disorders in general practice, to detect the eventual existence of particular clinical forms, to assess the frequency of comorbid disorders and to determine to what degree these disorders were diagnosed by GP's. Method - The study was conducted over 6 months in concert with 45 practitioners of the Aquitaine Sentinelle Network because of their strong experience in the field of epidemiological surveys, especially regarding psychiatric disorders. The population included all consecutive attenders aged 7 to 17 years. Consent to participate was obtained from children and adolescents and their parents. Finally 155 patients took part. A two-stage epidemiologic strategy was used, including screening tests in the first stage and semi structured interview by clinician in the second stage for diagnostic confirmation. During the first stage, information was obtained from children and adolescents and general practitioners using three questionnaires. The self-report questionnaire Center for Epidemiological Studies Depression (CES-D) was used for screening depression in 13 to 17 years old adolescents and the 20 items of the scale were modified to make it more comprehensible and relevant for children aged 7 to 12. The cut-off of 21 used in France appeared to be the more appropriate in both males and females and was taken to indicate high likelihood of depressive disorder. Therefore people with score 21 or more were approached for the second stage. The Child Behavior Checklist (CBCL), an instrument of well-established validity and reliability, provided information from parents about the child's behavior and competencies. Demographic and environmental data, as well as the reason for the visit and the presence of associated psychological factors were collected from a questionnaire devised for the study and completed by the practitioner. The 21 patients initially detected were invited to take part in the second stage. A total of 18 agreed to meet the psychiatrist. Sex-ratio female/male of this sample was 1,25 and mean age was 12,5 years. All of them underwent the Schedule for Affective Disorders and Schizophrenia for School Aged Children (Kiddie-SADS), a semi structured research interview of established validity. Diagnoses were made according to the DSM IV criteria (American Psychiatric Association). Results – Results showed that more than one child out of 10 aged less than 13 years had a depressive disorder, and that the prevalence in the adolescent sub-group was 5 %. Major depressive episode was present in 6 % of the children sample, dysthymia in 4 % and maladjustment disorder with depressive mood in about 1 %. All depressive disorders were moderate. Atypical depression (in the Anglosaxon sense of the term) was present in half of the depressed adolescents. Other disorders included anxiety disorders with a rate of about 4 % overanxious in the adolescent sample, obsessive compulsive disorder, panic disorder. Disruptive disorders were considerably less common. Psychiatric comorbidity, usually involving different types of emotional disorders, was present in about 50 % of psychiatric cases, with a prevalence of anxiety disorders. The reasons why depressed subjects consulted were not specific. The most common reasons for visiting the GP were the somatic complaints with a rate of 50 % in both populations, whatever the CES-D's score was. A few per cent of patients attending primary care presented with mental health complaints, and the rate was similar in the two populations. Frequency of consultation was not a discriminant factor of depression. Familial cohesion and school performance were not associated with the CES-D's score, nor familial psychiatric history. Personal psychiatric history was related to depression, whereas the occurrence of bereavement made the CES-D score positive but was not significantly associated with fully- blown depression. Finally, we estimated that 70 % of diagnoses of depression were not made during the consultation with GP's. Conclusion - No particular characteristic of depressed children consulting GP's could be established. These findings underline the importance of training GP's in the screening of depressive disorders in children and adolescents. A better knowledge that young general practice attenders have high rates of depressive disorders may facilitate more rapid referral for psychiatric assessment and treatment.


Mots clés : Adolescent , Dépression , Enfant , Épidémiologie , Médecine générale.

Keywords: Children and adolescents , Depressive disorders , Epidemiology , General medicine , Self-administered questionnaire.


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© 2003 Elsevier Masson SAS. Tous droits réservés.
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Vol 29 - N° 5

P. 391-400 - octobre 2003 Retour au numéro
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